Provider Demographics
NPI:1245548544
Name:J. E. RYAN ENTERPRISE, INC.
Entity type:Organization
Organization Name:J. E. RYAN ENTERPRISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LPC
Authorized Official - Phone:810-743-8316
Mailing Address - Street 1:4511 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1107
Mailing Address - Country:US
Mailing Address - Phone:810-720-3120
Mailing Address - Fax:810-742-2920
Practice Address - Street 1:G 4511 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1107
Practice Address - Country:US
Practice Address - Phone:810-720-3120
Practice Address - Fax:810-742-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801010818251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N72800OtherMEDICARE